Provider Demographics
NPI:1790386993
Name:ANIGWE, OBIORA FREDRICK
Entity Type:Individual
Prefix:
First Name:OBIORA
Middle Name:FREDRICK
Last Name:ANIGWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 WESTWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4002
Mailing Address - Country:US
Mailing Address - Phone:817-570-0827
Mailing Address - Fax:
Practice Address - Street 1:6770 WESTWORTH BLVD
Practice Address - Street 2:
Practice Address - City:WESTWORTH VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76114-4002
Practice Address - Country:US
Practice Address - Phone:817-570-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist